How does retin a help acne

Dose-dependent actions of adapalene at the molecular level. From Tenaud et al. The efficacy of individual topical retinoids increases with increasing concentration.

Tretinoin was first shown to have dose-dependent effects in animal models [ 24 ]. In two separate ultra-structural studies, 12 weeks of tretinoin therapy 0. Registration studies of adapalene gel 0. Analysis of the phase III study of adapalene gel 0. Most recently, the fixed combination adapalene 0. The higher concentration 0. Dose-dependent clinical success rate IGA of 0. From Weiss et al. In addition to affecting primary acne lesions, topical retinoids have also been shown to act on secondary lesions including scarring and pigmentation because of actions in the dermis.

Acne scarring occurs as a result of dermal remodeling and an imbalance between matrix degradation and matrix synthesis that is orchestrated by matrix metalloproteinases MMPs [ 29 ]. An open-label pilot study of adapalene 0. Further, adapalene 0. In pigmentary problems, topical retinoids lighten hyperpigmented lesions by inhibiting melanosome transfer to keratinocytes and reducing epidermal pigmentation by accelerating epidermal turnover [ 31 ].

Grimes et al. In a study comparing tazarotene 0. Griffiths et al. In an open-label study of South African acne patients with dark skin types, adapalene gel 0. In a week study, Bulengo-Ransby et al. There is a common perception that retinoids should be reserved primarily for comedonal acne [ 37 ]. Randomized controlled trials have provided strong evidence that topical retinoids as monotherapy significantly reduce inflammatory lesions, with an effect that is comparable to that on noninflammatory lesions Fig.

The beneficial effect of topical retinoids on inflammatory lesions is clear in before and after digital photos of patients undergoing topical retinoid monotherapy [ 37 ].

To evaluate the effect of topical retinoids on inflammatory lesions, Leyden et al. Five blinded investigators rated acne severity before and after 12—15 weeks of monotherapy with topical retinoids adapalene, tazarotene, or tretinoin. Significant clinical improvement in inflammatory acne was found for all retinoids; in addition, the degree of improvement increased along with worsening baseline acne severity [ 37 ].

In a recent systematic review, Jacobs et al. Clinical efficacy of topical retinoid monotherapy on inflammatory lesions after 12 or 15 weeks therapy. From Leyden et al.

Topical retinoid therapy can be accompanied by cutaneous irritation, including peeling, erythema, irritation, or dryness, which typically are observed in the first few weeks of treatment and then subside [ 42 ]. Clinically, retinoid-induced irritation is superficial, mild to moderate in severity, and limited to the epidermis [ 43 , 44 ].

During the process of normalizing desquamation, corneocyte arrangement can be disturbed with loss of cohesion [ 45 — 47 ]. After a few weeks of treatment, the corneocytes are re-arranged, desquamation normalizes, and irritation resolves [ 45 ]. In clinical trials of retinoids, the peak of cutaneous irritation typically occurs within the first 1—2 weeks and subsides thereafter [ 48 ]. The effect of retinoids on antiinflammatory pathways and on the microcomedo then becomes prominent Fig.

Changes over time in the skin with retinoid therapy, differentiating transient irritation versus inflammation. Retinoids have different receptor binding affinities to their target nuclear hormone receptors retinoic acid receptors or retinoid X receptors and cellular retinoic acid binding protein II CRABP II [ 12 ], and this variance is believed to account for differences in tolerability [ 7 , 12 ].

A systematic review of 34 clinical studies split-face comparisons and parallel designs showed that the frequency of clinically significant irritation was low with all three available topical retinoids adapalene, tazarotene, tretinoin [ 42 ].

Among studies with statistically significant results, adapalene gel 0. Tazarotene cream 0. Of note, the review authors reported that sensitive skin history of irritation with facial products was the most reliable predictor of irritation—superseding the effect of the specific retinoid, concentration, or formulation [ 42 ]. Leyden et al. The analysis assessed the influence of four variables on retinoid tolerability: concentration, vehicle formulation, skin sensitivity, and the specific retinoid.

The results indicated that vehicle gel vs. Generally, tolerability was better with normal vs. On both normal and sensitive skin, the best tolerated cream was tazarotene and the best tolerated gel was adapalene.

The results from this study agreed with the systematic review that the sensitivity of the facial skin has at least as much influence on tolerability as the choice of individual retinoid and more than the formulation or concentration [ 51 ]. The systematic review also assessed irritation with a fixed-dose combination product versus retinoid monotherapy and concluded that the tolerability of combinations was comparable to monotherapy [ 42 ]. Three of the studies included for evaluation allowed the use of moisturizers, and Culp et al.

They emphasize that few patients discontinued clinical trials because of irritation and stress the importance of strategies to minimize irritation [ 42 ].

In our clinical experience, there are a number of strategies that can help minimize the potential for irritation and patients with sensitive skin Table 1 [ 52 , 53 ]. Some of these, such as patient education, may require additional staff time but may also reward the practice via improved patient satisfaction with therapeutic outcomes [ 54 ]. Strategies to minimize tolerability issues [ 7 , 53 , 69 ]. It is important to encourage patients to optimize their skin care regimens, and patients can benefit from receiving recommendations for appropriate gentle cleansing and moisturizing products [ 53 , 54 ].

Good skin care can prepare the stratum corneum for topical therapies in several ways: reducing skin irritation and improving hydration as well as maintaining a correct pH balance [ 53 ]. Generally, antibacterial soaps are not recommended for acne; these agents do not impact P.

Synthetic detergent syndet bars and lipid-free cleansers are a better choice, cleansing the skin without a negative impact on epidermal barrier function [ 53 ]. Cleansing may be a very important area to address with the patient, since a substantial proportion of people including medical students erroneously attribute acne to poor skin hygiene or being dirty [ 55 , 56 ]. Predicting which patients will be susceptible to retinoid irritation poses a clinical challenge [ 57 ].

Increased risk for side effects was associated with the use of other topical medications OR 1. Thus, when utilizing topical tretinoin as part of a combination regimen—as is recommended for most patients with acne—it may be prudent to utilize one or more of the strategies listed in Table 1. Although P. Acne is not a traditional infectious disease, and approaches targeted solely to killing P. Topical BPO and antibiotics act by reducing P. In addition, BPO has some comedolytic properties, which occur secondary to reduction of free fatty acids [ 60 ].

Topical antibiotics are not recommended as monotherapy, but can be used in combination with BPO [ 7 ]. Combination therapy with topical retinoids and antimicrobials targets three major areas of acne pathophysiology: abnormal desquamation, P. Optimally, clearance should be sustained by a therapy that can prevent the majority of new lesion formation [ 53 ]. Acne often follows a chronic relapsing and remitting course, and it is important to have topical medications that decrease the formation of new lesions by targeting the microcomedo, the precursor of acne lesions [ 54 , 63 ].

The use of retinoids plus BPO targets multiple pathways and can often eliminate the need for antibiotics, reducing the likelihood of antimicrobial resistance [ 2 , 3 ]. Dosage may be increased to improve efficacy, since a dose-dependent relationship has been shown for retinoids. Fixed-dose combination formulations can help to streamline therapy, which may be expected to positively impact adherence.

Synergy is a term for when the actions of a combination prove to be greater than what might be expected from the sum of the efficacy of the constituents [ 66 ]. In a study of normal skin explants and biopsies from acne papules, Zuliani et al.

Synergy was also shown in the clinic. Tan et al. The efficacy of the fixed-dose combination product was significantly greater than its constituent molecules and exceeded the sum of the efficacy of adapalene alone plus BPO alone [ 65 ]. To our knowledge, no similar analyses have been performed on the other combination products currently available for the treatment of acne.

In addition, Osman-Ponchet et al. Skin penetration with 0. These results support clinical efficacy findings. The scientific rationale for use of topical retinoids in acne is clear [ 2 , 3 , 37 ].

Clinical data from many thousands of patients show these agents are highly efficacious on both noninflammatory and inflammatory acne lesions [ 3 ].

Expert groups and evidence-based guidelines agree that topical retinoids should be considered the foundation of acne therapy. The study and article processing charges were funded by Galderma International. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.

All named authors meet the International Committee of Medical Journal Editors ICMJE criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published. In the United States, skin care products and medications that contain tretinoin are only available with a prescription. This includes low-strength tretinoin products. In some countries, lower strength versions of tretinoin cream, gel and solution are available over the counter.

Although lower-strength tretinoin creams and other products are shown to treat acne and aging in most studies, research generally shows that stronger tretinoin products are more effective.

However, the majority of research into tretinoin also shows that side effects are more common in people who use higher-concentration tretinoin products, such as. Your healthcare provider will recommend the most appropriate tretinoin strength for you. If you have mild to moderate acne, this may mean a.

Depending on your reaction to tretinoin, you may need to adjust the change of your medication or adjust your usage habits over time. Like other acne medications, tretinoin needs time to have a noticeable impact on acne. For the most part, scientific research shows that it typically starts to produce improvements after about 12 weeks approximately three months. In one study from , people with acne who used a. Interestingly, although the.

Although a mild improvement was visible after four and eight weeks, the combined tretinoin and clindamycin treatment produced the biggest improvements after 12 weeks. Many tretinoin users experience improvements sooner, while others may need to wait for slightly longer than 12 weeks for optimal results. Several different factors may affect the amount of time it takes for tretinoin to clear acne lesions and improve your skin:.

The severity of your acne. If you have very severe acne, it may take longer before your skin clears after you start using tretinoin. The strength of the tretinoin cream. Most research suggests that creams containing a higher percentage of tretinoin for example, 0. How consistently you apply the medication. If you forget to use your medication or skip certain days, you may need to wait for longer to see improvements.

How sensitive your skin is to the effects of tretinoin. Some people experience faster results from tretinoin than others. Since no two cases of acne are identical, your results may take more or less time than the typical results timeline seen in studies.

Your use of other skin care products. Other skin care products, such as moisturizer or topical antibiotics, may enhance the results of tretinoin or affect its ability to be absorbed by your skin. These skin care products may cause you to experience faster or slower results while you use tretinoin.

Make sure to inform your healthcare provider about any other medications or skin care products you use before you start treatment with tretinoin. As we mentioned above, tretinoin may cause your acne to become more severe before it begins to clear up. During the first few months of using tretinoin, some people experience an increase in their level of facial acne. During this period, your acne may become more severe. You might notice more pimples forming on your skin than normal, or that your existing acne lesions seem to become more inflamed and painful than they were before you started using medication.

In some cases, you may also experience side effects of tretinoin, such as dryness, skin peeling and flaking. Not everyone experiences the tretinoin purge, but for those who do, it can often be a particularly unpleasant few weeks. Like with many things in life, the key to passing through the tretinoin purge successfully is a mix of patience and determination.

The tretinoin purge is almost always a temporary issue that will resolve on its own as your skin becomes more accustomed to the tretinoin cream or gel. You can get through it by focusing on the long term and thinking about how your skin will look once the medication starts working. They may suggest applying tretinoin less frequently or switching to a lower concentration cream to reduce the severity of your symptoms. However, in some cases, tretinoin may cause more severe side effects that require treatment and attention.

Although uncommon, tretinoin may cause more severe side effects, such as itching, hives and pain or discomfort. Our list of common and uncommon side effects of tretinoin offers more information on the side effects listed above, as well as the steps that you can take to manage them. Overall, severe side effects from tretinoin are rare. In the event that they do occur, they almost always stop when you adjust your dosage or stop using the medication.

Tretinoin has been approved by the FDA as a treatment for acne since the late s. During the last three decades, it also received approval by the FDA as a topical treatment for wrinkles and other common signs of skin aging.

The first is that tretinoin may cause complications if you have certain skin conditions, including atopic dermatitis eczema. One study, from , analyzed the efficacy of standard. At the end of the week study, which included 1, participants, researchers concluded that both the standard tretinoin gel and the tretinoin gel microsphere significantly reduced inflammatory and noninflammatory lesions vs the placebo group.

At the end of the week study, researchers found that a mix of of tretinoin and clindamycin reduced acne by from Cystic acne is a severe form of acne. While regular acne develops when a hair follicle becomes clogged with a mixture of oil and dead skin, cystic acne forms when a clogged hair follicle becomes infected with bacteria. When bacteria makes its way inside the follicle, it can cause inflammation. Infected pimples can become red, swollen and filled with pus.

They may become itchy, irritated and can be painful if accidentally bumped or touched. Worse yet, cystic acne can spread easily. If one infected pimple bursts, the bacteria can easily get stuck under your fingernails or trapped inside other hair follicles, causing a major outbreak elsewhere on your face or body that can affect your skin for months at a time. Just like regular pimples, cystic acne is most common in teenagers and people in their early- to mid-twenties.

Because cystic acne is caused by a combination of acne and bacteria, most doctors use two medications as part of a treatment program: a retinoid such as tretinoin, or in cases of severe or persistent cystic acne, isotretinoin in conjunction with an antibiotic to help reduce inflammation and kill bacteria.

Some common antibiotics used in combination with tretinoin to treat cystic acne are tetracycline antibiotics like doxycycline , minocycline and tetracycline.